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MBS updates GPs need to know


Morgan Liotta


2/11/2020 4:52:26 PM

A number of changes to the Medicare Benefits Schedule came into effect on 1 November.

Close up of Medicare card
Changes to MBS items for angiography and blood product services are among those relevant to general practice billing.

newsGP unpacks the latest Medicare Benefits Schedule (MBS) updates concerning GPs.
 
CT angiographies
The introduction of Medicare Benefits Schedule (MBS) item 57357 for computed tomography (CT) angiography of the pulmonary arteries.
 
GPs will now be able to request CT angiography for the exclusion of pulmonary embolism without consultation with a non-GP specialist first. 
 
Since 1 May 2020, items for CT angiography have excluded all scans of the pulmonary arteries requested by GPs, but the Federal Government has since acknowledged misinterpreting MBS Review Taskforce (the Taskforce) recommendations. The restriction between vascular ultrasound of regions other than the lower-limb and musculoskeletal ultrasound of the lower-limb is being removed.
 
These changes are relevant to providers delivering and claiming CT angiography and vascular ultrasound services and requesters of those services. Provider billing arrangements from 1 May will need to be adjusted to reflect these changes.
 
In November 2018, the RACGP made a submission to the Taskforce report from the Diagnostic Imaging Clinical Committee (DICC) on diagnostic imaging items related to different body areas and systems.
 
The college supported the DICC’s recommendations that, in the areas of CT of cervical spine and head and musculoskeletal ultrasounds, research on the reasons underpinning observed GP requesting patterns should be undertaken before making recommendations for changes to item numbers.
 
The college’s submission also noted that restricting some CT angiography to requesting non-GP specialists only may create unnecessary barriers to patient access.
 
Blood product services
Following a comprehensive review by the Taskforce informed by the Blood Products Working Group, other healthcare professionals and patients, changes to MBS items for blood products were recommended to improve clarity on healthcare provision and prevent misuse.
 
The updated blood product items include:

  • item 13703 – blood transfusion procedure
  • item 13760 ­– in vitro processing and cryopreservation of bone marrow or peripheral blood procedure.

Item 13709 – collection of blood for autologous transfusion – has been determined as no longer clinically appropriate and will be deleted from 1 November. For transfusions of blood already collected, item 13706 is appropriate to claim. For intra-operative autologous blood transfusion, item 13703 is appropriate.
 
According to the MBS, the updated items ‘better describe the scope of conditions treatable based on contemporary evidence-based best practice and will help to ensure clarification on appropriate use’ and align the MBS with the National Blood Authority and international guidelines.
 
These changes follow the RACGP’s November 2018 submission to the Taskforce on the Blood Products Working Group report.
 
In response to the Working Group’s proposed amendment of the descriptor for item 13760 to specify that the item be for use ‘as part of a treatment program overseen by a multidisciplinary [cancer] team experienced in the treatment of malignant disorders’, the college sought clarification on the definition of ‘multidisciplinary teams’ – specifically what practitioners are suitable members of this cancer team and if it considers such teams will include GPs.
 
The 1 November changes include updates to the descriptor of item 13760 to better describe the scope of cancerous conditions claimable and clarify contemporary clinical best practice. An explanatory note details the service requirements needed to bill the service, as well as the international guidelines for the treatment.
 
However, a clear definition of who is considered part of a multidisciplinary cancer team is lacking.
 
Urology
Changes to urology services relate to general urology, urological oncology (including treatment for benign prostatic hyperplasia), endo-urology and renal stone disease, paediatric genitourinary and reconstructive urology, incontinence and urogynaecology. The revised structure includes an addition of 20 new items and deletion of 13 items.
 
The Taskforce found that some urology items did not reflect current clinical practice or required clarification to address inappropriate co-claiming behaviour.
 
These changes have been made to encourage best practice and are relevant for all healthcare providers involved in the performing and claiming of eligible urology services.
 
The descriptor for item 30654 – circumcision of the penis other than item 30658 – has been amended to mandate the use of analgesia for this procedure.
 
Item 30658’s descriptor has been amended to clarify the type of analgesia for this procedure.
 
The RACGP provided a submission to the Paediatric Surgery Advisory Group in December 2019 regarding the proposed amendment to the descriptor for item 30654 to include use of topical or local analgesia for circumcision.
 
The college recommended the removal of item 30654 and amendment of item 30658 to include general sedation, local or topical analgesia according to the clinical need, to ‘avoid the financial incentive toward general anaesthesia while providing a more realistic rebate for the service’.

It also advocated for a GP survey to ‘better understand the circumstances and reasons for performing circumcision procedures’.
 
Other MBS changes from 1 November
 
  • Chemotherapeutic procedures ­– 11 existing items to be replaced with one, item 13950 – parenteral administration of one or more antineoplastic agents. The changes will provide healthcare providers with a simplified structure for chemotherapy procedures listed on the MBS, more accurately reflecting their involvement in the oversight and management of therapeutic agents and the side effects.
     
  • Neurosurgery and neurology services – changes include additional, amended and deleted items for neurosurgery and neurology services to promote high-quality use of electroencephalogram, nerve conduction studies, electromyography and central nervous system evoked responses. A range of other changes will be made to simplify the MBS by consolidating neurosurgical services that are commonly done together into a single Medicare item.
     
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